By Natalia Guzman-Manzano
In the summer of 2022, I spent one month in rural regions of Peru, particularly the outskirts of Cusco. The region was cold, the people were friendly and the culture ran deep. Many Andean traditions with Inca roots remained prominent, including the use of plant-based medicine and a reliance on the land for daily life. For this reason, many individuals chose not to live in the “big city” of Cusco, instead residing in small mountain towns. My job that month was to assist Peruvian physicians in managing pop-up clinics that would reach these communities.
A group of 15 other students and I spent our first week training to support the effort. Cultural sensitivity and emergency preparedness were emphasized because we were entering communities that had not received medical attention in months, if not years. We practiced simple Spanish phrases, learned how to ask respectful questions and reviewed common conditions, such as gastrointestinal issues and diabetes complications, that we might encounter. Our main responsibilities included taking vitals, organizing supplies, dispensing medications, managing patient flow and teaching preventative behaviors.
On the first day of the clinic, I was incredibly nervous to meet the community members. I worried I would make a mistake that might hurt someone or lead them to distrust the physicians. Our first patient was a mother seeking help for her baby, who was having digestive issues. She allowed me to listen to the child’s digestive tract with a stethoscope, and the physician identified the likely cause of the pain. Then, I stepped outside and taught the children waiting for their visits how to properly wash their hands and brush their teeth. For the adults, I flipped through posters about breast cancer and spoke about behaviors that could increase risk and symptoms to watch for. The day was going surprisingly well; we saw close to a hundred patients, and most were able to receive medication or treatment.
About an hour before the day ended, a middle-aged woman walked in. She appeared healthy and was there for a quick check-up. I began taking her vitals: heart rate, blood oxygen saturation and respiratory rate. When I put the blood pressure cuff on her, however, the result was shocking: 175/95, a number that could indicate severe hypertension and put her at risk for a stroke, heart attack or other life-threatening complications if left untreated. I naively assumed it was a mistake and reran the machine, but it gave me the same alarming result. The physicians saw her immediately, and the clinic erupted into panic as we tried to find transportation to the nearest hospital. The patient, however, did not want to go. The hospital was too far away and too expensive, and she would rather take medication to lower her blood pressure. Despite all the warnings, she decided to go home, and she never returned to the clinic.
After that clinic day, access became a constant topic of conversation between the physicians and us students. They believed that if the hospital had been closer, the patient would have had more routine checkups to catch and manage her high blood pressure sooner. What struck me most was that her decision did not come from ignorance or stubbornness, but from practicality. She weighed the distance, the cost, the time away from home and the uncertainty of what would happen at the hospital, and she chose the option that felt most feasible in the moment. Although we never learned what happened to her after that emergency, her case highlighted an issue present not only in rural Peru, but around the world.
For many people, accessing healthcare is too complicated or costly, leading them to neglect their health until it is far too late. Health concerns are easily minimized when it takes an ‘arm and a leg’ to schedule an appointment, make it to that appointment and pay for care. In rural areas especially, it is unrealistic to expect individuals to set aside several days to travel to a physician, losing necessary income and expending significant effort. Material and physician shortages, as well as insufficient infrastructure and funding, further limit the ability to reach rural populations. Change begins with recognizing these disparities between urban and rural areas and taking steps toward equity. This could include increasing funding and improving transportation of necessary materials to hard-to-reach regions. Public health is not truly public health unless all populations are considered, even those most easily forgotten. Unnecessary emergencies and deaths can be mitigated to improve outcomes for everyone, not just those who are wealthy and live where health care is more accessible.
Natalia Guzman-Manzano is a third-year public health major.
“My Public Health Story” essays originated from an assignment on public health storytelling for a public health messaging and dissemination course led by Gaia Zori, Ph.D., M.P.H., coordinator for the social and behavioral sciences and public health practice concentrations in the Master of Public Health program.